Erythema nodosum leprosum with genital ulceration - A rare and interesting case report

Erythema nodosum leprosum (ENL) is a type III hypersensitivity phenomenon seen in the lepromatous spectrum of leprosy. Involvement of external genitalia is very rare, and genital mucosal involvement is still rare. We report a 39-year-old man with episodic fever, red raised skin lesions predominantly in the lower extremities, and painful genital ulcers for 1-month duration. Genital examination revealed two irregularly shaped, mildly indurated, punched-out tender ulcers with yellowish slough on an erythematous base. Bilateral ulnar and common peroneal nerves were moderately thickened, more on the left side with bilateral stocking type of anesthesia associated with the left side fixed ulnar claw hand and left foot drop. By appropriate investigations and therapeutic elimination, the patient was diagnosed as borderline lepromatous Hansen's disease with type 2 reaction and grade 2 deformity. This case is reported for the rare occurrence of ENL lesions involving the genital mucosa in the form of ulceration.